title: Multicenter study of robotic thyroidectomy: short-term postoperative outcomes and surgeon ergonomic considerations.
abstract: BACKGROUND
  Robotic thyroidectomy (RT) has recently emerged as a viable approach to thyroid surgery, resulting in better functional and cosmetic outcomes than afforded by open thyroidectomy (OT). The present multicenter study assessed the perioperative outcomes of RT and compared physician perspectives on the musculoskeletal ergonomic parameters associated with OT, endoscopic thyroidectomy (ET), and RT.
  
  
  METHODS
  We reviewed the medical records of 2014 consecutive patients who underwent RT, conducted by 7 surgeons, at 4 centers between October 2007 and June 2010. Patient characteristics, perioperative clinical results, complications, and pathologic outcomes were analyzed. Moreover, surgeons were surveyed to gather data on musculoskeletal discomfort experienced during OT, ET, and RT.
  
  
  RESULTS
  Of the 2014 patients, 740 underwent total and 1274 subtotal thyroidectomy. Mean tumor diameter was 0.8 cm, and the mean number of retrieved central lymph nodes was 4.5 ± 3.9 (range 0-28). The rates of permanent recurrent laryngeal nerve injury and permanent hypocalcemia were 0.4 and 0.05%, respectively. Neck and/or back pain after OT, ET, and RT was experienced by 100, 85.7, and 28.6% of surgeons, respectively. When surgeons ranked the operative approaches in decreasing order of associated pain, 57.1% indicated ET > OT > RT, 28.6% selected OT > ET > RT, and 14.3% responded ET > RT > OT.
  
  
  CONCLUSIONS
  RT is a feasible and safe procedure that may facilitate radical cervical lymph node dissection. Moreover, for surgeons, the RT resulted in less musculoskeletal discomfort than did OT or ET. A larger prospective study, with a longer follow-up, is needed to determine whether RT offers real benefits for both patients and surgeons.
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea. ljd0906@hanmail.net
authors.forename: Jandee
authors.initials: J
authors.lastname: Lee
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Jeong Ju
authors.initials: JJ
authors.lastname: Jung
authors.forename: Un Jung
authors.initials: UJ
authors.lastname: Choi
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Yun
authors.forename: Kee Hyun
authors.initials: KH
authors.lastname: Nam
authors.forename: Euy-Young
authors.initials: EY
authors.lastname: Soh
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D061226:Recurrent Laryngeal Nerve Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012371:Robotics; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D055815:Young Adult